ATRIAL-FIBRILLATION - ANTIARRHYTHMIC THERAPY VERSUS RATE CONTROL WITHANTITHROMBOTIC THERAPY

Atrial fibrillation is a major health problem in the United States, bu t the best strategies for treating it have not been rigorously determi ned in clinical studies. Specifically, there is a paucity of data comp aring the approach of maintaining sinus rhythm using prophylactic anti arrhythmic drug therapy with the approach of controlling the ventricul ar response to atrial fibrillation while reducing embolic events with concomitant antithrombotic therapy. Until ongoing randomized trials ar e completed, which patients benefit most from a specific approach cann ot be determined with certainty. In general, the most reasonable strat egies include (1) the restoration of sinus rhythm (without prophylacti c antiarrhythmic therapy) after the patient's first episode of atrial fibrillation; and (2) the maintenance of sinus rhythm (including the u se of prophylactic antiarrhythmic therapy) in patients who remain symp tomatic despite adequate rate control, and who are not at high risk fo r proarrhythmia and/or are unlikely to maintain sinus rhythm. The risk s and benefits need to be carefully weighed in patients with truly asy mptomatic atrial fibrillation. Many patients may require multiple atte mpts to maintain sinus rhythm. Current investigative treatment modalit ies (e.g., ablation techniques, atrial implantable cardioverter-defibr illators, new antiarrhythmic agents) are likely to alter the current a pproaches to atrial fibrillation. (C) 1997 by Excerpta Medica, Inc.